Use of Microsurgical Technique for Revascularization of the Spinal Cord

S.P. Mironov, G.A. Stepanov, I.G. Grishin, V.G. Golubev, A.V. Baskov, Z.G. Natsvlishvili, S.V. Russkikh, I.N. Karpov, V.I. Amin, G.I. Khokhrikov, N.A. Eskin, M.V. Kapyrina

(Priorov Central Institute of Traumatology and Orthopedics, Moscow;
Municipal Clinical Hopsital N 19, Moscow;
Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow)

Vascular disorders are one of the leading factors of dystrophic changes of the spinal cord in its trauma.

Microsurgical operations, aimed at revascularization and reinnervation of the spinal cord and developed in the Priorov Central Institute of Traumatology and Orthopedics, are as follows: free grafting of a greater omentum segment with applying microsurgical technique, translocation of an intercostals neurovascular bundle for revascularization and simultaneous reinnervation of the spinal cord.

There were 14 cases, aged 18-43, with traumatic disease of the spinal cord, who were operated during the last two years. Trauma was sustained 1.5-9 years ago. The spine cord was injured at the level of Th1-Th2 (7 cases), C5-C7 (4 cases), C2-C4 (2 cases) and L1 (1 case).

Multimodality examination, carried out preoperatively in all the cases, included laboratory studies, clinical and functional studies, MRI, CT, electromyography. Spinal angiographic examination according to Tissen was aimed at determination of a level of circulatory disorders in a zone of the spinal cord trauma.

Cases with traumas of the cervical spinal cord had marked hypoplasia of intercostal vessels, which hampered applying microvascular anastomoses. Thus, we improved our technique of using occipital vessels on cadavers.

Occipital arteries and veins were sources of blood supply of the greater omentum segment, implanted into the cervical spinal cord. Blood circulation within this segment was estimated by means of duplex scanning with color coding. Spinal angiography, used in 1 case 6 months after operation, demonstrated good patency of microvascular anastomoses.

A follow-up period was 1.5 years on the average. Taking this fact into account, we analyzed remote results according to the following scheme. Improvement was regarded as presence of positive subjective (a better general and emotional condition) and objective signs (better trophism, less marked motor and sensory disorders, better sexual function). Cases, operated 2 months ago, were referred to a group with no changes. More marked sensory disorders and greater spasticity were considered to be a state aggravation.

According to the above scheme, a state of 9 cases improved; there were 4 patients with no changes; aggravation was watched in 1 case.